A Handbook for New Ostomy Patients

Transcription

A Handbook
for New
Ostomy
Patients
Produced by the
Vancouver Chapter of the
United Ostomy Association of Canada
fifth edition, 2012
A Handbook
for New
Ostomy
Patients
Produced by the Vancouver Chapter
of the United Ostomy Association of Canada
fifth edition 2012
The fifth edition of A Handbook for New
Ostomy Patients is made possible by the
generous financial support of
Elaine Antifaev, E.T. RESOURCES Ltd.
Ostomy Clinic and Medical Supply
Centre
White Rock, BC
604-536-4061
The Vancouver Chapter of the UOA of Canada
encourages free distribution and copying of this
publication for the benefit of all ostomates. If you are
using portions of this handbook for inclusion in other
publications we ask that the Vancouver Chapter of the
UOAC be acknowledged. Thank you!
IMPORTANT NOTICE:
This publication is written and compiled by people who
have had the same surgery as you. It contains practical
advice and tips for managing and learning to live with an
ostomy, and is meant to supplement, but not replace, the
information given to you by your doctor, ET nurse or other
health care professional.
The information in this publication is of a general nature,
not specific medical, or other professional, advice. If you
need medical, or other professional advice or assistance,
consult your doctor or ET nurse as soon as possible.
We believe the information in this publication is correct
and will be useful, but by using this publication you
agree that the Vancouver Chapter of the United Ostomy
Association of Canada, its members, directors and officers
will not be liable to you for any injury or loss caused by
your use of this information.
First printing ............................ June 2006
Second printing ...........................June 2007
Third printing ..............................July 2008
Fourth printing..............................July 2010
Fifth printing..............................November 2012
I
n North America alone, there are approximately 70,000
new ostomy surgeries performed every year. If you are
reading this, chances are you have already had ostomy surgery
or are about to.
Colostomies, ileostomies and urostomies are performed on
people ranging in age from infants to the elderly, for a wide
variety of causes. Birth defects, disease, complications from
other surgeries or childbirth, and severe injury are all reasons
why ostomy surgery may be necessary. Whether the ostomy
is permanent or temporary, it can be a difficult adjustment for
the patient, and for their family and loved ones.
This handbook is based on the experience of those who have
had ostomy surgery and/or live with an ostomy. We’ve been
through what you may be experiencing and understand the
frustrations and fears you may have. It is our hope that this
handbook can help answer your questions and reassure you
that there is much good life to be lived after ostomy surgery.
6 Handbook for New Ostomy Patients
Table of Contents
Choosing the Right Appliance
9
Terminology
Two piece vs one piece
Convex appliances
10
11
12
Food, Diet and Nutrition
13
Resuming a normal diet after surgery
Problem vegetables
Food charts
Alcohol
Prescription drugs and over the counter remedies
Controlling waste with diet
Use of Imodium and similar products
14
14
15
17
17
18
19
General Managagement
21
Changing, emptying
Night drainage systems
Cleaning your equipment
Disposal of used appliances
Colostomy irrigation
Misc products
22
23
23
24
24
25
Potential Problems and How to Avoid Them
29
Bowel obstructions
Dehydration
Hernias
Folliculitis
Prolapsed stoma
30
32
33
35
36
Common Concerns
37
Leaks and odours
Skin Barrier Rings
Odour control
Sex and intimacy
38
39
40
42
Sports and Exercise
45
Protecting the stoma during sports
Keeping the appliance on during sports
46
47
Travelling, camping and places far from home
Using public washrooms
47
49
Internal (J-Pouch) Surgery
51
What is J-pouch surgery?
Candidates for J-pouch surgery
Dietary guidelines
Cautions and Potential Problems
52
52
53
55
Specific Groups
59
The elderly
Infants and children
Ostomates receiving chemotherapy
Pregnancy with an ostomy
Gay and lesbian ostomates
Muslim ostomates
60
60
61
63
64
64
Most Commonly Asked Questions
67
Tips & Tricks
71
Emotional Issues
for the Patient and Their Family
75
Coming home
Spouses, family and caregivers
76
77
Additional Resources & Information
79
Manufacturers
80
Suppliers
81
Does Medical Coverage Include
Ostomy Supplies?
83
ET Clinics & Resources
84
Connect with Others on the Internet
85
About the UOA Vancouver
89
Application For Membership
Acknowledgements
91
92
Choosing
the Right
Appliance
Choosing the Right Appliance
First of all, a bit of clarification on terminology. You may have already
heard different terms and are confused about just what exactly they
refer to. ‘Bag’ or ‘pouch’ refers to the part that collects waste. ‘Flange,
‘barrier’, ‘wafer’ or ‘faceplate’ all refer to the part that sticks to your
body. The general term ‘pouching system’ refers to the entire system
(one or two-piece) that is used. The general term ‘appliance’ is also
sometimes used.
Pouches (or bags), whether they are one or two-piece can also come
in ‘closed end’ or ‘drainable’ models. A drainable pouch has a clip
or velcro closing on the end that can be undone to release waste. A
closed-end pouch has no opening or clip, and is removed and discarded
instead of emptied. Many pouches are now made with filters near the
top which allow gas to escape without odour.
The material that the barrier (or flange) is made out of can come in
different types, too. Some are called standard wear and other are
extended wear. In general, a standard wear barrier is used when stool
is semi-formed or formed. An extended wear barrier is usually used
when a stoma drains urine or stool that is loose or liquid. The extended
wear barrier does not break down like a standard wear barrier when it
comes in contact with liquid waste.
Most hospitals in the lower mainland employ one or more ET nurses,
who are also referred to as enterostomal nurses. These are nurses
who have taken specialized training in ostomy care. You will be
discharged from the hospital with a supply of appliances chosen by
your ET nurse to get you started. (You will be billed for this first batch
of appliances.) After that you must purchase your own. But where to
start and what to buy? The variety of appliances available can seem
bewildering at first. Two-piece, one piece, closed, drainable, different
sizes, different brands -- how does one choose? No one expects you
to learn it all at once. You may find that the product introduced to
you by your ET nurse or hospital works well and stay with that, or you
may not be satisfied with the look or performance of your first type
of appliance. We encourage all new patients to learn about different
brands and types and to try new appliances. Your ostomy may be
permanent or it may be temporary -- either way you owe it to yourself
to find and wear the best possible choice for you for as long as you will
have the ostomy.
The United Ostomy Association does not endorse one brand or type
over another -- all have merit. What works well for one patient may
not suit another, and what one person swears by others don’t like.
Everyone has different needs and preferences. The most prevalent
brands in our area are Coloplast, Convatec and Hollister. Sometimes
your ET nurse can give you something different if you call and ask.
Another option is to contact the manufacturers directly. All have
websites and toll-free numbers you can access for free samples. This
is a good way to ‘test drive’ a new type of appliance without spending
a lot of money. Call the suppliers up, tell them what sort of ostomy
you have, and what your particular concerns are. It can take several
weeks for samples to arrive, so be patient. If you don’t care for what
was sent, you can ask for more samples. Companies want you to try
their products! It’s definitely worth your time to check out what they
have to offer. You can also attend open houses sponsored by various
pharmacies or clinics to talk directly with ostomy sales representatives
and get samples. It is beyond the scope of this publication to discuss all
systems and brands, but this is a short guideline. For numbers to call,
see manufacturers’ listings in the back of this handbook.
Two-Piece vs One-Piece Pouching Systems
A two-piece appliance is composed of two parts: the flange, which
sticks to your skin, and the pouch, which snaps or sticks onto the
flange. A one-piece appliance has the flange combined with the pouch.
There are advantages and disadvantages to both:
Two-Piece Advantages
- easier to ‘burp’, that is, allow gas to escape. This is a useful feature for ileostomates/colostomates who find that filters work poorly once dampened
- a smaller or larger pouch can be substituted without having to change the entire flange
- some have a ‘floating flange’ which is a type of flange that has an extra flexible join at the circular ring. This can be an advantage for those 11 Handbook for New Ostomy Patients
with poorer hand dexterity who have difficulty snapping a pouch onto a flange, or for those whose abdomen is very tender and pressing down to attach a pouch is uncomfortable.
Two-piece disadvantages
- tend to be bulkier and more visible under clothing, although with the newer thin and flexible flanges this is less of a problem than in years past
- more appliance ‘inventory’ to purchase, match and keep track of
One-piece advantages
- fewer components to apply
- feel lighter, more flexible and have a lower profile under clothing
One-piece disadvantages
- can cost more if you are using closed-end models (you’ll need to
throw them away every time you empty)
Convex Appliances
If you have a very short, or flush stoma, you will probably need to
use what is called a convex appliance. These are available in one or
two-piece the same as standard appliances. The difference between a
convex and a regular appliance is the flange is shaped in such a fashion
around the opening so that when applied, it presses down on the skin
around the flush stoma. This makes the stoma stick out more. Stomas
that are too short or flush do not always drain into the bag properly,
causing leakage, so a convex flange may correct the problem. If you
think your ostomy falls into this category, you should ask your ET if a
convex flange might work better for you.
Pouch Liners
These are flushable, very thin plastic liners that fit inside a two-piece
pouch. When it comes time to empty, you simply remove the liner and
flush it down the toilet, leaving your pouch empty and clean. These are
popular with those who prefer using a closed-end appliance. At about
15 cents per unit, flushable liners can help save costs if this is a concern.
Colo-Majic, the company that markets these, is British Columbiabased; you can inquire about them from your ostomy supplier.
Foods,
Diet and
Nutrition
Resuming a Normal Diet after Surgery
COLOSTOMIES AND UROSTOMIES
After the bowels have healed after surgery, colostomates and urostomates are usually able to return to their previous eating habits with
little or no alteration. However, you should exercise some caution and
common sense when eating for a week or two after you leave the hospital, just to be on the safe side. Chew your food well and take it easy
with things like nuts, fruit skins, raw vegetables and popcorn.This applies as well to those who have undergone radiation to the pelvic area,
as portions of the remaining bowel can be irritated by this treatment.
ILEOSTOMIES
It was once thought that many types of foods were strictly off-limits to
ileostomates, but this need not always be the case. Ileostomy surgery
removes most or all of the large bowel and may change how your body
processes food. Ileostomates need to learn how their new body reacts
to the foods they used to eat, and how to carefully re-introduce these
items back into their diet. If you have an ileostomy, you need not fear
mealtimes, just exercise moderation to start and CHEW YOUR FOOD
WELL. Soups, blender drinks and soft cooked items are gentle on a
healing system. Raw fruits and vegetables or their skins may be hard to
pass through your system. Although fibre is good for you and necessary
for a balanced diet, you may need to experiment with what agrees and
what does not. Fibre is not as necessary for those with ileostomies.
Below are some common foods and hints on how to safely eat them
for those recently returned home from ostomy surgery. (See lists on
pages 15 to 16).
Vegetables
Vegetables like celery, asparagus, and broccoli can have long fibrous
strands running through them. Such strands are hard to digest and can
‘ball up’ causing a painful blockage. When eating such vegetables, peel
off the outer tough stalk, or eat only the tender ‘hearts.’
Asparagus can cause odour in the urine. Onions can produce odour
in the stool. Broccoli, cauliflower, and turnips are gas producers.
Whatever gave you gas before will continue to give you gas.
For some people, mushrooms, especially fresh ones, are notorious for
going through the system undigested or causing blockages. Slice them
thin and yes . . . chew, chew chew. Corn on the cob, canned corn and
popcorn are also often the cause of bowel obstructions or blockages.
Eat these in moderation. If in doubt about trying a vegetable for the
first time, peel the skin, and steam or soft-cook it. Beets can turn waste
pink or red -- this is harmless.
Fruit
Fresh fruit can, and should, be included in a well balanced diet. If you
are having trouble digesting oranges or grapefruit, try squeezing the
juice and discard the skin and pulp. Try peeling apples, pears, plums
and peaches to start off. Be cautious with fresh coconut. You may be
able to eat all of the above items right away, however, post-surgery it’s
best to approach fruit with caution and moderation. Keep in mind that
fruit is also a natural laxative that may increase bathroom visits. (for
colostomies and ileostomies)
Nuts and Meats
Hard nuts such as peanuts, almonds and hazelnuts should be
introduced in very small amounts and chewed well. Peanut butter will
act as a stool thickener in some people, which can help with diarrhea.
Most meats and poultry do not present major problems but steak,
chops, roasts or hamburger must be carefully chewed and consumed
in moderation. High fat items, heavy casings on sausage, and gristle
may be more difficult to digest after ileostomy/colostomy surgery. Eat
slowly, avoid the gristle and limit your intake.
Spicy Foods
Heavily spiced foods and sauces can act as cathartics (cause loose stool)
and gas producers.
Foods that increase odour
asparagus
broccoli
brussels sprouts
cabbage
cauliflower
beans
eggs
fish
onions
some spices
Foods that increase gas
beans
beer/carbonated soda
broccoli
brussels sprouts
cabbage
cauliflower
corn
cucumbers
mushrooms
peas
radishes
spinach
dairy products
excess sugar
Foods that thicken stool (slow output)
applesauce
bananas
cheese
boiled milk
marshmallows
pasta
creamy peanut butter
pretzels
rice
bread
tapioca
toast
yogurt
bagels
oatmeal
Foods that loosen stool
green beans
beer
broccoli
fresh fruits
grape juice
raw vegetables
prunes/juice
spicy foods
fried foods
chocolate
spinach
aspartame/Nutrasweet
leafy green
vegetables
High-fiber foods that may cause blockages
dried fruit
grapefruit
nuts
corn
raisins
celery
popcorn
coconut
seeds
coleslaw
Chinese vegetables
oranges
meats with casings
Can you still drink alcohol?
Yes! And you may find that gastrointestinal upsets associated with
alcohol that used to occur before surgery are now gone with the
removal of the diseased bowel. A word of caution however: those with
ileostomies are at greater risk of dehydration when drinking alcohol.
Have water on the side, or extra juice or pop along with your drink.
Unless a fair amount of the large colon was removed, colostomates
are in little danger of dehydration when drinking liquor. Beer and
carbonated drinks can produce gas. Some medications are less effective
if taken with alcohol -- be sure to follow instructions. Alcohol may give
you loose output or extra output, or it may have no effect on waste at
all. Everybody’s different.
Urostomates need not fear dehydration but you will be making more
trips to the bathroom to empty your appliance.
Prescription Drugs and Over the
Counter Remedies
Prescription and non-prescription drugs as well as vitamins are
absorbed primarily through the intestines, therefore if you have had
a significant portion of your bowel removed, absorption of these
substances can be affected.
While the chemical nature of most drugs allows absorption along
a significant length of the intestinal tract, the shorter the functional
intestine, the less will be absorbed. Only a very few drugs, such as
alcohol, can be absorbed to any great extent through the stomach.
Absorption of medications can vary depending on the size and type
of pill (ie tablet or capsule). Chewable tablets are effective if they are
chewed well; in most cases they are better absorbed than capsules or
compressed tablets.
Ostomates who have a significant portion of their intestine removed
may achieve better absorption by emptying the contents of a capsule
into applesauce, or crushing a compressed tablet and adding the
powder to food. A word of caution, though -- not all tablets can safely
be crushed, and not all capsules should be emptied. Generally speaking,
time-release tablets should not be crushed, nor should time-release
capsules be emptied. The result could be 12 to 24 hours worth of
medication being released all at once. Time release medications should
be avoided by ileostomates or discussed with their pharmacist.
Enteric-coated tablets should not be crushed. The reason those tablets
are coated is to prevent irritating the lining of the stomach. If possible,
avoid this type of tablet as they can pass intact through your system.
FOLLOW INSTRUCTIONS FOR TAKING ALL DRUGS. If in doubt
about an over-the-counter drug, or how different drugs may interact,
consult your pharmacist or doctor.
CAN YOU CONTROL THE AMOUNT OF WASTE
PRODUCED BY SELECTIVE DIET?
Obviously, if you stop eating, you will have little or no output.
Starving yourself or limiting liquids to avoid producing waste is foolish
and dangerous. NEVER restrict fluid intake -- the consequences of
dehydration are serious for an ostomate. Sticking to regular mealtimes
can help you learn your body’s behaviour patterns and anticipate the
times when your output is lowest. Some people eat less at certain
times of the day or evening in order to help make their stoma less
active. Skipping meals entirely will not stop ileostomy output however,
and can produce more gas than if you ate a regular meal.
Some foods do produce more waste than others, for example, things
that contain cellulose will produce more residue and hence, more
output. Cellulose is the chief component of plants, so it stands to
reason that consumption of most fruits and vegetables will increase
output. Refined grains such as white rice or white bread produce
relatively little residue, as do things like eggs, cheese or chicken.
Examples of foods that thicken or slow output are oatmeal, peanut
butter, marshmallows and bananas. Drinking large amounts of fluids will
not affect stool output; it will increase urine output. Bear in mind that
you cannot control your ostomy completely with selective diet.
Use of Imodium and Similar Products
Give your body time to settle down after you leave hospital. Some
colostomates can have loose stool for several weeks or longer after
surgery. This should sort itself out in time without the use of antidiarrhea agents. Even after you have healed completely, you may
have periodic bouts of diarrhea the same as a person with an intact
digestive tract -- it can happen to anybody. But before reaching for
an antidiarrheal you should first consider what you may have recently
consumed that might be the cause. In most cases, periodic looseness
will sort itself out after a day or two without the need to take anything.
However, patients with chronically overactive colostomies and
ileostomies sometimes use agents such as Imodium to help control
things.These should be used only if the situation is chronic and not
improving by watching your diet. Follow directions and do not exceed
the recommended dosage. Lomotil is another antidiarrheal available
only by prescription; its use should be discussed with your doctor.
Occasional diarrhea is not a cause for panic; as much as possible give
your body time to adjust on its own. If you take Pepto Bismol, be
aware that your stool will turn black. This is harmless.
General
Management
GENERAL MANAGEMENT
How Often Should you Change Your Appliance?
Whether you choose a two or one piece sysptem, 7 days is the
recommended maximum time a flange should be on your body.
Some people can successfully stretch this considerably longer without
compromising skin health or hygiene, but don’t try to set records. Three to
four days is perfectly acceptable wear-time.
How long you choose to wear, or can wear a flange depends on how your
skin reacts to being covered with this material, your technique in applying,
and upon the placement of the stoma itself. Some people get too itchy to
keep one on for more than a few days. Some can keep an appliance on for
long periods of time without any discomfort. Some people have the sort
of skin and ostomy placement that won’t hold a flange on properly without
using an ostomy belt or extra products. And some people can change their
entire appliance every day without irritating their skin. We’re all different.
How Do You Empty your Pouch?
Most people sit to empty their pouch. Let it fall between your legs,
open the clip or valve and let the stool or urine drop into the toilet.
Colostomates and ileostomates should wipe the inside of the pouch end
with tissue before re-clipping to avoid odour. Some people prefer to kneel,
facing the toilet although this can be hard on the knees. Some prefer to
stand -- if you prefer this method you should put some tissue in the toilet
bowel first to control splashing.
How Often Should You Empty?
All categories -- colostomy, ileostomy and urostomy -- should empty when
the appliance becomes one third full, or sooner. Waiting longer than this
can make you uncomfortable, puts unnecessary strain on the flange and
can contribute to leakage. How many times do most people empty per
day? This varies depending on type of ostomy, what you’ve been eating
and drinking and also on what your tolerance is for having waste present
in the bag. Very generally speaking, colostomates empty 3-4 times a day,
ileostomates 6 to 8 times a day and possibly during the night as well,
urostomates 10 to 12 times per day. If you want to empty more
frequently than this, by all means do so. It’s your body and you should
do what you need to feel clean and comfortable. Many urostomates
use a night drainage system. (See next topic)
Night Drainage Systems for Urostomates
Urine will collect in the appliance continuously throughout the day
and night. Urostomates should use a night drainage system rather than
rely on waking up during the night to empty a full appliance. Letting a
urostomy appliance get overfull during the night is asking for leakage.
Night drainage systems consist of a tube which is connected to the
drain spout at the bottom of your appliance, and then connected to
either a collection bag or bottle kept beside your bed. Most of the
major suppliers make night drainage tubing and collection devices.
You should discuss these products and how to use them with your ET
nurse.
How Should You Clean Your Appliance?
Trying to clean inside an appliance while you’re still wearing it is largely
a waste of time (not to mention near impossible) and you really don’t
have to do this. What you should do is wipe inside the pouch end with
toilet paper after each empty and before re-clipping to avoid odour. If
stool is ‘pancaking’ inside or near the top of your pouch you can use
a plastic squirt bottle of water to rinse this out. (Take care that you
don’t flush water around the stoma as this may get under the flange.)
Adding a few drops of ostomy lubricating deodorant or baby oil inside
the pouch before applying it helps stool slide to the bottom rather than
collecting at the top.
If you wear a flange with a two-piece system, sometimes the inside
of the ring can become soiled which bothers some people. Q tips can
help clean this but don’t make yourself crazy trying to get the flange
ring 100% clean. You’re going to cover it anyway once the pouch is
applied.
Urostomates should rinse the night drainage system every day -- it’s
advisable to use a mild vinegar/water solution and flush the tubing and
collection device. Some manufacturers also market cleaning products
specifically for your urostomy gear.
How Should You Dispose of Used Appliances?
People can get way too complicated about this. Once you’ve drained
the pouch into the toilet, put it (and the flange if you are changing that
as well) in a plastic bag like one of those you get from the grocery
store, or a small zip lock bag. Buy yourself a little plastic waste basket
with a lid and keep it under the bathroom sink. Put your bagged waste
in there and take it out regularly. If you’re in a public washroom and
must dispose of a used appliance and don’t have a plastic bag, wrap it
up in toilet paper and put it in the nearest wastebasket. Ladies have the
added advantage of having disposal units for menstrual products inside
public cubicles -- you can use these. Far too many people are anxious
about this subject -- believe us, nobody is watching what you throw
away and so long as you’re tidy, nobody cares. Ostomy waste is not
radioactive, folks.
Colostomy Irrigation
Those with a descending or sigmoid colostomy have another option
for managing their ostomy. Irrigation is a water enema administered
through the stoma, either once a day or once every other day. The
procedure takes about an hour in the privacy of your own bathroom,
and requires a minimum of specialized equipment. Irrigation works
on the principle that if all or most of the large bowel is emptied at one
time, it will take 24 - 48 hours for stool to output again. Irrigators
who achieve good control can be freed from wearing, emptying
and changing standard ostomy bags, and report a dramatic
improvement in quality of life. In between irrigations, the stoma
is inactive, or produces very small amounts of stool, allowing the
individual to wear only ostomy caps, patches or mini-bags to protect
the stoma. To be a candidate, you must have a reasonable amount of
hand/eye coordination, the capacity to learn and remember a simple
sequence of steps and the motivation to control your body. If your
bowel habits were regular before surgery, your chances are good that
your remaining colon will respond well to irrigation. If bowel irritability
was common before your surgery, or if you were prone to diarrhea,
irrigation may not be much of an improvement for you. If you have
a hernia, or serious heart or kidney disease, you should see your ET
nurse or doctor to discuss the adviseability of irrigation.
Irrigation can be safely commenced once your incisions and stoma have
healed completely. If you are required to undergo chemo or radiation
after surgery it may be advisable to wait until you have completed
treatment before trying irrigation, although in some cases where
patients tolerate treatment well, you might be able to start sooner.
You will need to contact your ET nurse for an appointment to receive
instruction on technique and what equipment to purchase. (If you want
the nurse to do the procedure with you for the first time, you should
let them know so they can book an adequate amount of time for your
session. Otherwise, you can start at home after verbal instruction.)
The Vancouver Chapter has members who irrigate who will be happy
to act as irrigation mentors and coaches after you have seen your ET
on this matter. Your nurse can refer you to irrigation mentors. Patients
with a urostomy, ileostomy, or ascending colostomy cannot irrigate. In
rare cases, transverse colostomies can irrigate but results are generally
too poor to justify the effort. If you have been told that you cannot
stop irrigation once you start because the bowel will no longer work,
or that you must adhere to a rigid timetable, this is simply not true.
You can stop anytime you wish if irrigation does not suit your lifestyle
and although it is recommended that you adopt a routine timetable
for elimination [much as you probably did prior to surgery] this can be
modified to suit your own schedule.
We strongly encourage descending or sigmoid colostomates to look
into irrigation.
Miscellaneous Products
Paste
Paste comes in tubes or as packaged sticks which can be squeezed
or moulded by hand. Paste is often misused and, it could be argued,
misnamed. (It could be said that ‘putty’ might be a better term). This
product should not be used as an adhesive. The main purpose of paste
is to fill in any uneven areas on the skin under the flange to make the
skin level, and gain a good seal to the flange. The second function of
paste is as a caulking material around the base of the stoma to keep
discharge from leaking at the base and getting under the wafer. Apply
a small bead of paste, like putting toothpaste on a brush, around the
opening in the flange. Let this sit for a minute to give the alcohol a
chance to evaporate. Do not spread the paste. If you want to remove
paste from your skin, let it dry out a little first. Don’t worry if a little
bit is left on your skin. Recap the paste tube immediately after use to
prevent it from drying out. You don’t need paste if your skin is even and
the appliance is staying on well.
Powder
Skin barrier powder may sometimes be recommended by your ET to
dry a raw, weepy area on your skin. To apply, clean the irritated area
with water and pat as dry as you can. Lightly dust the powder over the
affected area and smooth it evenly. Blow or brush off the excess and
apply your pouch as usual over top. Some people dab or spray a skin
sealant over the powder before applying their flange.
Skin Sealant
Skin sealant (sometimes called barrier film or skin prep) puts a plasticlike coating on the skin. It comes in the form of sprays, wipes and gels.
A sealant may help if you have skin that tears easily, have problems with
leakage or are using an ostomy skin barrier powder. Some people who
have dry or oily skin find that their pouching system sticks better when
they use a skin sealant. Most skin sealants contain alcohol which will
sting on open areas of skin, or skin that is sensitive.
No-alcohol sprays and wipes such as Cavilon may be used if regular
sealants are too irritating. Nexcare No Sting Bandage is also alcohol
free and does essentially the same job as Cavilon.
Ostomy Adhesive
Adhesive cements and sprays are not as widely used these days, but
may be helpful for those who are having a lot of trouble keeping a
flange in place. A light, even coating should be applied and given time to
dry before applying the flange. It is important to follow manufacturer’s
instructions, as many adhesives require 3 to 5 minutes to dry properly.
Adhesive Remover
A sticky residue can sometimes build up on your skin. Ideally, you
should remove this with mild soap and water, but if it’s not coming off
you may need to use an adhesive remover. After using this product you
should wash the skin well with mild soap and water, then rinse and dry
completely.
Tapes
Common brands are Micropore or “pink tape” and can be purchased
over the counter at most drug stores. These products are skin-friendly
(can be removed without damaging the skin) and can help keep a hardto-stick flange secure. People often tape the edges of their flange for
extra security if engaging in sports or swimming although most appliances these days hold up well in water.
Absorbent Gel
Some manufacturers make absorbant gel products designed specifically
to convert liquid ileostomy waste into a more solid and easily managed
consistency. Gel can be in powder form or packaged in a dissolvable
film packet which is dropped into the pouch each time the pouch is
emptied or cleansed. As the pouch fills, the packet dissolves and liquid
waste becomes more solid, reducing pouch noise and the chances of
peristomal irritation. Ask your supplier or ET about this product.
Ostomy Belts
An alternative way to keep your appliance in place during vigorous
activity is to wear an ostomy belt. These are elastic belts that hook
onto the small loops on your pouch or flange. Ostomy belts are also
helpful in holding the flange snugly to the body, preserving the seal and
helping prevent leakage.
All these products! does everybody have to use
all this Stuff?
No -- many people with ostomies use none of the above products. It
depends on your skin and stoma type -- some folks have very dry or
very oily skin, some are prone to irritation, some have a hard-to-fit
stoma due to siting, shape, scarring or body type. Your own stoma and
skin may fit none of these categories and you don’t necessarily have
to use skin sealants, paste and the like. It helps to know about these
products if you run into problems with leakage or skin irritation, otherwise you may not need to use them at all. If you’ve been using a lot of
products and wonder if you really need to, try an appliance change or
two without them. Whenever possible, make your routine as simple as
you can. “Less is Better” really applies in ostomy care.
Potential
Problems &
How to Avoid
Them
POTENTIAL PROBLEMS AND
HOW TO AVOID THEM
The following conditions are not necessarily common, but they can
happen. Knowing how to identify, treat and avoid them will help you
prevent them.
Bowel Obstructions: How to Know if
You Have one, and What to Do Before
You Call the Doctor
Bowel obstructions, or blockages, can occur in colostomies but are far
more common with ileostomies. An obstruction is usually caused by
eating something fibrous or difficult to digest, such as popcorn, celery,
or tough meats to name a few. Eating too quickly, not chewing your
food well enough, or introducing solid foods too quickly to your system
after surgery can result in a bowel blockage. Blockages can be mild
and resolve themselves, or they may be extremely painful and require
hospitalization. It’s important that you know how to avoid them, how
to identify them if you think you have one, and what to do should you
experience a blockage.
Signs and symptoms of a possible blockage:
• Swollen stoma
• Distention of the abdomen
• Minimal or no stomal output
• Cramping and pain
• Nausea and vomiting
Symptoms may become severe or they may last for more than 24
hours. There are several things you should do if you suspect you have a
bowel obstruction and several things you absolutely should not do:
DO NOT:
- eat solid food
- take laxatives or pain killers
- insert anything in the stoma
DO:
- stop eating
- drink non-carbonated fluids; warm fluids may help
- check to see if the stoma is badly swollen, if so you should remove the flange and replace it with one that has a larger opening
- soak in a hot bath to relax the abdominal muscles
- massage the abdomen or try a knee-to-chest position; walk
- call your doctor or go to emergency if severe symptoms are not going away
- have someone drive you to hospital
Treatment for severe blockage may include an IV to replace the fluid,
sodium, and potassium you have lost and the administration of pain
medication. An X-ray or other diagnostic test may be conducted to
determine the source of the obstruction. Depending on the patient and
the suspected culprit for the obstruction, a tube may be inserted into
the stomach via your nose to decompress built-up pressure.
Be alert to the early signs and symptoms of bowel obstruction. A
partial blockage usually displays itself through cramping abdominal pain,
watery output with a foul odour, and possible abdominal distention and
stomal swelling followed by nausea and vomiting. A complete blockage
with an ileostomy is evident when there is total absence of output
for more than 4 hours, severe cramping pain, abdominal and stomal
swelling, and nausea and vomiting.
Some common blockage-causing foods are popcorn, nuts, heavy
fibre (such as that found in the stalks of celery), fruit skins, and poorly
chewed meat. Strip tough fibre out of celery stalks and peel fruits such
as apples. Cut meat into small pieces and chew your food properly
rather than washing things down with liquid. Introduce fresh fruit and
vegetables slowly to your system, in small amounts.
DEHYDRATION
The large intestine does not play a major part in absorbing nutrition; although it absorbs some minerals, notably salt, its main job is to extract
water from waste coming from the small intestine. If all or much of the
large intestine is removed, the patient loses this natural ‘rehydrator’
and can be at risk for dehydration. Therefore, dehydration affects ileostomies more than any other type of ostomy. Thirst is not always an
accurate measure of your body’s needs; those with ileostomies should
develop the habit of drinking water throughout the day. (8 to 10 glasses
per day is recommended.)
Symptoms :
Mild Dehydration: (increase fluid intake -- and for babies, call a medical professional): Thirst, dry lips, dry mouth, flushed skin, fatigue, irritability, headache, urine begins to darken in color, urine output decreases
Moderate Dehydration: (call a medical professional): All of the signs
of mild dehydration, plus: skin doesn’t bounce back quickly when
pressed, very dry mouth, sunken eyes, (in infant - sunken fontanel, the
soft spot on the head), output of urine will be limited and color of urine
will be dark yellow, cramps, stiff and/or painful joints, severe irritability,
fatigue, severe headache and increased heartrate
Severe Dehydration: (call emergency number): All of the signs of
mild and moderate dehydration, plus: blue lips, blotchy skin, confusion,
lethargy, cold hands and feet, rapid breathing, rapid and weak pulse,
low blood pressure, dizziness, fainting, high fever, inability to pee or cry
tears, disinterest in drinking fluid
Ileostomates should make a habit of drinking more fluids per
day than they did before surgery.
HERNIAS
A hernia is a portion of intestine that bulges out of a weakened area of
the muscle wall of the abdomen. In those with an ostomy, some individuals may be susceptible to hernia formation around the stoma.
Contributing causes of stoma hernia:
• Coughing, being overweight or having developed an infection in the wound at the time the stoma was made
• Improper lifting, lifting too heavy an object anytime after surgery (less than 5 lb for 6 to 8 weeks post-operatively is recommended)
• Engaging in strenuous sports
Hernias develop most often in ostomates around the stoma. Because a
small circle of abdominal muscle was removed during surgery to bring
the intestine to the surface, a weak spot was created. Lifting too heavy
a load can cause the the intestine to protrude through this gap. In some
individuals even sneezing, coughing or standing up can make the bowel
bulge through this weak spot.The size of a hernia may increase as time
goes by. Parastomal hernias are rarely painful, but are usually uncomfortable and can become extremely inconvenient. They may make it
difficult to attach a bag properly and sometimes their sheer size is an
embarrassment as they can be seen beneath clothes.
Although it is a rare complication, the intestine can sometimes become
trapped or kinked within the hernia and become obstructed. Even
more seriously the intestine may then lose its blood supply, known as
strangulation. This is very painful and can require emergency surgery to
untwist the intestine. Regardless of inconvenience or pain, hernias are
defects in the abdominal wall and should not be ignored simply because
they might not hurt. Some surgeons advocate that small stoma hernias
that are not causing any symptoms do not need any treatment. Furthermore, if they do need treatment it should not be by surgery in the
first instance but by wearing a wide, firm hernia belt. This is probably
true with small hernias, in people who are very elderly and infirm or
people for whom an anaesthetic would be dangerous (serious heart or
breathing problems, for example.) Operative repair of a stoma hernia
may be necessary to improve the quality of life, prevent progressive
enlargement of the hernia and make it easier to manage the stoma.
Give your muscles time to heal and introduce physical activities slowly
and gently.
How you can help prevent
a peristomal hernia
For the first two to three months after surgery, try not to do activities
that put stress on your abdomen:
• Do not lift, pull, or push anything more than 5 pounds.
• Do not do any heavy exercise.
• Try not to strain your abdominal muscles (sneezing, hard coughing,
or straining to have a bowel movement [constipation].
Talk to your surgeon about any specific limits for you.
Support or hold your abdomen with a pillow or your hand(s) to help
give your abdominal muscles some support if you cough or sneeze.
Regular physical exercise such as walking and swimming are good for
overall health and wellness.
Some specific exercises that can help strengthen your body’s core are:
Two (2) months after your surgery:
Pelvic tilt
• Lie on your back on a firm surface with knees bent and feet flat on
the floor or bed.
• Make sure your feet, ankles, and knees line up and are hip-width
apart.
• Tighten your abdominal muscles, pulling your bellybutton down
towards your spine.
• Tilt your bottom upwards slightly while pressing the middle of your
back into the bed.
• Hold this position for 2 seconds.
• Slowly relax back to your start position.
• Repeat 10 times.
Knee rolling
the floor or bed.
• Tighten your abdominal muscles.
• With your knees bent, drop them slowly down to one side then to
the other side.
Chest Lift
the floor or bed.
• Make sure your feet, ankles, and knees line up and are hip-width
apart.
• Place your hands on the front of your thighs.
• Tighten your abdominal muscles, pulling your bellybutton down
towards your spine.
• Tilt your chin slightly down.
• From the top of your head, slowly lift your head and upper spine off
the floor or bed (just far enough that the bottoms of your shoulder
blades are still touching the floor or bed).
• Hold for 3 seconds.
• Slowly return to your start position
Note: Some people are at more risk for developing a hernia. Your
stoma nurse may recommend the use of a binder or belt to help
prevent a hernia after discharge.
Folliculitis
Folliculitis is an inflammation of the hair follicles and happens most
often in men. It is usually caused by traumatic hair removal, for
example, hair under the flange that is pulled out when the flange is
removed. If your skin has become irritated with this, usually the use of
a skin protective powder will permit the skin to heal.
If you suspect you may have folliculitis, you should see your ET nurse
to confirm and treat the problem.
Men can avoid this condition by carefully shaving the skin that will be
covered by the flange. You can use either an electric or safety razor
for this. Shaving in the direction of hair growth may help avoid skin
irritation.Tip: if you’re nervous about shaving so close to your stoma,
an empty cardboard toilet roll makes a good shield around it.
Prolapsed Stoma
A prolapsed stoma is a stoma that begins to hang noticeably farther
and farther out of your body without retracting. This is not normal and
should be reported to your ET nurse.
It’s normal for your stoma to change in length slightly throughout
the day but this should not be confused with a true prolapse. Your
stoma can look contracted and almost flush with your skin, minutes
later it may appear soft and look longer. This minor variation in length
is normal stoma behaviour. It can react to cold or being handled by
contracting and ‘shortening’ up. Paristaltic waves can also make the
stoma look shorter or longer. They can look, and feel, either hard or
soft depending on whether or not contraction is happening. What is
not normal is if you notice your stoma is looking consistently longer
and starting to hang out of your body more than usual. Measure your
stoma’s length after six weeks and if you notice it is getting longer, you
should have your ET nurse check it. Prolapsed stomas are inconvenient
and more prone to injury. There is no ‘standard’ stoma length -- they
can be less than half an inch long, or up to an inch and a quarter.
Common
Concerns
COMMON CONCERNS
LEAKS AND ODOUR
Although leaks and accidents can and do happen to all of us, they are
by no means the norm and you should not accept constant leakage as a
part of living with an ostomy. Most of the time accidents are caused by
the appliance not being put on correctly, or by being poorly fitted and
it’s common for beginners to make errors.
Common causes of leakage:
• The flange opening not cut to the right size. The flange opening
should be cut approximately 1/16” larger than the stoma diameter. If
it’s too big waste can get under the flange onto your skin. If it’s too
small your stoma will be pinched, or displace itself under the flange.
A new stoma will shrink in circumference for up to 8 weeks after
surgery. It should be measured with each appliance change, with the
new flange cut accordingly.
• Wearing the same flange for too long
• A poorly placed stoma. You may need to adjust your beltline if it’s interfering with how the stoma empties.
• Dislodging or loosening the flange during physical activity. You might consider using an ostomy belt to keep the flange on firmly.
• A very flush stoma that does not exit waste into the bag properly. Consider using convex flanges to correct this problem.
• Flanges not sticking properly. Your skin needs to be completely dry and clean before applying the flange. Avoid using soaps that leave a residue. An uneven abdomen can make it difficult for the flange to stick properly; you may need to use ostomy paste or a skin barrier ring to achieve a good firm fit.
• Folds or creases. If skin folds or creases have developed and leakages are always along the crease, wafer pieces or ostomy paste can be used to build up the area in order to avoid leakage. See
your ET nurse for ‘how-to’ information.
• Peristomal skin irritation. Pouches don’t stick well to irritated skin, so perform meticulous skin care to avoid irritated or denuded skin or a rash. If any of these problems develop, see your ET nurse as
soon as possible.
• Improper pouch angle. If the pouch doesn’t hang vertically, the weight of its contents can exercise an uneven pull on the wafer, and cause leakage. Every ostomate must find his or her optimal angle, based on individual body configeration.
• Waiting too long to empty the pouch. Pouches should be emptied when one-third full or sooner. If allowed to overfill, the weight of
the waste can break the seal and cause leakage.
• Extremely warm temperatures. Leakage in warm temperatures may be due to wafer ‘melt-out’. More frequent pouch changes or a change in wafer material may be required to avoid leakage.
• Pouch wear and tear. If you are stretching your wear times to a week or more, leakage may be due to the wafer wearing out. Try more frequent pouch changes.
• Faulty appliances. Although it is not common, some batches of appliances can leave the factory with flaws. If you suspect your appliances have pinholes or faulty seams you should stop using items
from that box, and report and return the unused items to your
supplier. Manufacturers want and need to know if their products
are not performing! (Note: please don’t send used faulty appliances
through the mail . . . the manufacturer will take your word for it,
honest.)
What are Skin Barrier Rings and How do you use
them?
People with chronic leakage and fitting problems, or very sensitive
skin may find using skin barrier rings beneficial. The rings, or seals, as
they are sometimes called, are similar to a flange, but made out of
different material that is hypoallergenic and soothing to the skin. Rings
come in two sizes and can be molded or stretched by hand to custom
fit around the stoma, and increase the adhesion of the flange, which is
applied over top. Sometimes pieces of the ring material are all that’s
required to address a small problem area. You should see your ET for
help learning to apply a barrier ring correctly. ‘Eakin Seals’ has been the
most recognizable and popular brand of ring for many years, however,
other companies are developing their own versions. Each brand is
worth your time to check out. Ask your supplier what’s new on the
market.
ODOUR CONTROL
This is one of peoples’ first major concerns. Colostomies tend to emit
more odour than ileostomies because of the bacterial abundance in
the colon. When sigmoid and descending colostomies are irrigated,
odour is much less evident. Ileostomates experience almost continual
peristaltic waves which sweep the ileum and prevent stagnation of
the intestinal contents, thereby eliminating much of the bacterial
growth that occurs with colostomies. Urine has a characteristic
smell, but a foul odour could be a sign of infection. Certain foods will
affect the odour of both feces and urine -- eggs, onions, spicey foods,
cabbage, and fish to name a few -- you may want to cut down on your
consumption of these if odour is bothering you. Proper appliance
application is critical to avoid odour-causing leaks. Here are some
other tips and products:
Pouch deodorant. All the major companies offer bottles of liquid
ostomy deodorant. Try all the different products as individual body
chemistry makes a difference in how well each brand works. A few
drops of this in the pouch can help dispel unwanted smell. Ostomy
manufacturers are coming out now with gels and liquids that function
as both pouch lubricant and deodorizer at the same time. Ask your
supplier for samples.
CLEAN THE TAIL OF YOUR DRAINABLE POUCH! Emptying
regularly is important but just as important to odour control is wiping
out the inside of the end of the pouch tail before you replace the clip.
Try to keep stool from collecting, or “pancaking” at the top of
your pouch, as this can contribute to leaks and wafer undermining.
Pancaking is a common annoyance, especially if you are spending a
lot of time lying down or sitting. Clothing that restricts the top of the
pouch can also cause pancaking. Lubricating products from ostomy
manufacturers work well when put inside the top of the bag when you
you change to help things slide to the bottom. If no ostomy lubricant
is handy, vegetable oil or spray will work too, although such oils don’t
mask odour.
Internal deodorant products. A popular over-the-counter tablet is
Devrom (bismuth subgallate) available through your ostomy products
supplier or at some pharmacies. These are chewable tablets taken
right after you eat a meal, or more frequently throughout the day
depending on how much effect you want. The usual dose is one or two
tablets at a time. Devrom is pretty effective if you take it regularly and
most people report it eliminates or reduces gas and stool odour. The
drawbacks are you have to carry and remember to take the tablets.
You can also purchase chlorophyll capsules at your local health food
store, which produce a similar effect, that of neutralizing the bacteria
which produces excess odour in fecal matter and gas. Devrom can turn
your stool very dark and chlorophyll can turn your stool green. This is
harmless. You’ll need to experiment with internal deodorants to find
which work better, and how much to take.
Powdered charcoal supplements are ineffective and can contribute to
blockages in some individuals. Do not take these internally for odour
control.
•
•
•
Cranberry juice may help reduce odour for urostomates.
Eat parsley! Next time you get a sandwich with parsley garnish don’t throw it away! It’s one of nature’s best deodorizers.
Probiotic yogurt may cut down on odour in some individuals
You can spray room deodorant in the bathroom if you dislike the smell
after you have emptied your appliance. Candles and incense work
too. Some manufacturers market ostomy sprays you can use for this
purpose.
Some people find that their appliances develop an odour that they
dislike despite their best efforts to keep everything clean. Everybody’s
body chemistry is different and some folks can wear one brand without
annoyance while others think it smells. If your appliance is fitting you
well, you’re not getting leaks and nobody else can smell anything but
you still don’t think it smells right, you might consider trying other
brands. Changing the pouch more frequently often helps.
You’ll be more self-conscious about scent for a while after you have
an ostomy. This sensitivity will diminish over time as you gain in
confidence.
SEX AND INTIMACY
Resuming sexual relations after surgery can be an anxious time. What
do you do with the bag? What if your partner finds it offensive? How do
you tell a prospective partner about the ostomy? Can you have sex at
all?
The answer to the last question is yes, of course. Women with an
ostomy have no physical impediment to intercourse, although stenosis
(narrowing) of the vaginal canal is a common side effect if your surgery
required removal of the anal sphincter. If the anus has been removed,
intercourse may be uncomfortable or painful. Generous use of lubricant is key, as is a gentle partner. Stenosis of this sort usually eases over
time in sexually active women.
Men may face more challenges. Erectile dysfunction is more common
after urostomy surgery than ileostomy or colostomy surgery. How long
this lasts will vary depending on:
•
•
•
type of surgery performed and how invasive it was; how much nerve damage may have occured
the man’s age at time of surgery
his general health condition
Returning to sexual relations may happen after a few weeks, or it may
take months. It’s alright to masturbate if you want, so long as you
aren’t experiencing any pain while doing so. If you have healed well and
are otherwise in good recovering health after six months and are still
not happy with your sexual performance, you should see your doctor. Impotence can happen to any man, not just those with an ostomy.
Treatment prescribed usually consists of oral medication such as Viagra,
Cialis or Livitra. In all cases, dosage, method, and possible side effects
must be thoroughly discussed with your doctor.
Practical Considerations During Intimacy
It goes without saying that you should empty your appliance before
intimacy and take care that you are clean and have no odour. Folding
the bag up and taping it to your abdomen can get it out of the way and
stop it from distracting you. (any more than you’re already distracted,
that is.) If you are feeling self-conscious sometimes camisoles or ‘adult’
lingerie can make things more discreet for the ladies. Men may keep a
T-shirt on so the appliance is less obvious. The plastic in some appliances can rustle in an annoying manner -- those with fabric covering
are quieter. It’s a good idea to have some tissue, or a towel nearby in
case of surprises. All ostomy manufacturers make appliances that can
be used during intimacy -- stoma caps or mini-bags. These are much
smaller than a standard pouch and very discreet. How long they are
effective depends greatly on what sort of ostomy you have and what
its output patterns are. Colostomies tend to work slowly and only
during certain times of the day, so you can expect to get several hours’
use out of a cap or mini. Ileostomies will get much less time, depending on when you last ate. (Ileostomates often choose their intimate
moments before eating in order to have less worries during sex.) Caps
are not advised for urostomates; mini-bags will not have the capacity
to last very long, either. Regardless of what kind of ostomy you have, if
you want to give these products a try you should wear one for a while
before engaging in sex to see how effective it’s going to be.
When and how you choose to resume sexual relations is a very personal decision; above all remember that communication with your spouse
or partner is essential. Talk about intimacy in advance and try not to
put too much pressure on each other to do everything you did before
right away. Remember that your spouse or partner may be as nervous
and self-conscious as you are!
Whatever your previous sexual practices were before, you should be
able to return to these activities if you choose -- just bear in mind that
the stoma should be unrestricted during intimacy. You may wish to discuss any concerns about the safety of sexual practices with your doctor,
ET nurse or counsellors in the field of sexuality. Other ostomates can
be a good resource as well, for they may share similar concerns and be
willing to have a personal discussion.
Single people often worry about how to tell a new partner about their
ostomy. How and when do you tell? Get to know the person before
making the decision to take the relationship to the next step. When the
time is right, explain to them that you’ve had surgery that has left you
with some alterations to your body that will have an impact on intimacy. Answer any questions honestly and simply. Never spring an ostomy
on a new sexual partner without telling them well beforehand -- you’ll
be putting both of you in a potentially embarrassing situation. Just as it
took time for you to get used to your body, others will need time, too.
Sexual rejection is hurtful for anyone, not just those with an ostomy. If
someone you are interested in is suddenly not interested in YOU after
they learn you have an ostomy, consider this a clear sign that they were
not the right person for you in the first place. You must move on and
remember there are many others out there with a less shallow outlook. Don’t let fear of rejection keep you from finding the right partner.
Sports &
Exercise
SPORTS & EXERCISE
You should begin walking in moderation after your surgery and do this
regularly, every day after you get home. Walking stimulates the return
of bowel function and will get you back on the road to regaining the
muscle you lost while in hospital. Whatever sports you may have played
in the past, you can enjoy them again with few exceptions. Common
sense is required, of course and this mean NO heavy lifting during the
weeks immediately following surgery. Unless your surgery was done
laparascopically, your abdominal muscles will have been weakened by
incisions and must be given adequate time to heal. Improper lifting, or
lifting too heavy a weight too soon could cause a hernia. Again, NO
lifting, not even a vacuum cleaner or laundry hamper for those first
few weeks and then only introduce light loads gradually and carefully.
If you want to return to the gym you can do this but you should avoid
abdominal exercises for a while, and then only introduce these in
gradual, gentle amounts. A personal trainer, if you can afford one, can
work with you to develop a safe exercise regime.
Ostomates who regain previous fitness levels can and do return to
a huge variety of sports and exercise -- running, swimming, biking,
snorkelling, golf, hiking, hunting, yoga, riding, team sports, triathalon
-- you name it. The list includes contact team sports as well - professional footballers have played with an ostomy. Unless your
chosen sport before was power lifting or wrestling, you will probably
be able to do it again.
Protecting the Stoma During Sports
Stomas are fairly hardy, but some common sense rules apply. Stomas
should be protected from direct physical blows, from too tight
clothing, and from rigid objects (ie: belt buckles) over them. Ostomates
engaged in contact sports should consider protecting their stomas by
wearing a stoma guard and if desired, an abdominal /surgical support
belt as well.
A stoma guard is similar in function to a male athletic cup and is held
in place with an ostomy belt. Abdominal/surgical support belts aren’t
‘belts’ per se, but more like corsets that close in front with velcro.
They come in different sizes; you can make them as tight or loose as
you want. It’s like wearing armour and can boost confidence if you’re
anxious about being bumped in crowds or groups. They can be worn
under clothes but they’re bulky and rather restricting.
The main danger to a stoma during strenuous sports is being cut or
lacerated. Because the stoma itself has no nerve endings, you can be
injured without knowing it. Causes of stomal laceration include shifting
of the wafer, too small an opening, and rigid items too close to it. You
don’t want to overdo things, but stomas can withstand a bit of rough
and tumble.
Keeping the Appliance on During sports
Ostomy belts are useful, as is taping the appliance around the edges. If
you sweat a lot, you should check your flange periodically -- you might
need to change if a game is ongoing and you feel the appliance slipping.
And Very Important . . .
HYDRATION. Especially for ileostomates -- drink lots of water if
you’re exercising, playing sports or just out for a long walk.
TRAVELLING, CAMPING AND PLACES
FAR FROM HOME
The cardinal and never-to-be-broken rule of air travel is: CARRY ALL
SUPPLIES ON BOARD IN YOUR HAND LUGGAGE. No matter
how reliable the airline, NEVER pack supplies in checked luggage.
Lost supplies can be hard to locate and replace. At best, you’ll waste
valuable holiday time finding what you need. If you cut your own
flanges, do so before you travel. Some lengths of ostomy scissors are
now allowed onboard flights if you explain their use, but you can’t be
sure they won’t be confiscated. Pack your scissors in checked luggage,
and cut everything you’ll need beforehand.
Current airline restrictions prohibit liquids over a very small amount
from being taken onboard a flight. This can pose a problem on long
flights for ileostomates who must maintain their fluid intake. If you
cannot purchase water or juice in restricted areas, ask the cabin
attendant for water or juice at the earliest opportunity.
Customs officials may or may not ask to inspect your hand luggage
-- if they do, don’t worry about it. If asked what this is, tell them you
have an ostomy and these are your appliances. They may or may not
understand what an ileostomy or urostomy is; colostomy is generally a
more familiar term. Security scans will not damage your appliances.
If your travels include long flights or bus rides, you may want to wear
a larger appliance for this. Urostomates who know they may face
unusually long delays between bathroom breaks may want to consider
a leg bag. Ask for an aisle seat as close to the bathrooms on a plane as
available; choose the back of a bus that has toilet facilities. For other
modes of transportation, such as trains, just make note of where the
toilets are. Cruise ships are an easy travel choice for ostomates plus
they all have medical centres on board. A word of caution, however -‘medical centre’ does not necessarily mean they stock ostomy supplies.
Most do not and although the ship’s doctor will be happy to issue a
medical prescription for appliance purchase at the next port of call, the
next port of call could be days away. TAKE ALL SUPPLIES WITH YOU,
ALWAYS. Never rely on being able to purchase things ‘along the way’.
The other cardinal rule of travelling with an ostomy is “PACK AT
LEAST TWICE WHAT YOU THINK YOU’LL NEED”. One good bout
of traveller’s diarrhea can go through a lot of appliances in a hurry!
Seat belts in cars or airplanes can pose a problem if they cut across
your stoma. This may be uncomfortable and/or the stoma may not
drain properly into the pouch. You may need to loosen the belt,
or place padding between the stoma and the belt to even out the
pressure.
If you like to hike and camp, take an adequate supply of plastic bags
with you to deal with disposal. Don’t you DARE bury used appliances
in the woods!! Pack out all your non-biodegradable ostomy waste. Your
water needs may be greater, so plan ahead for adequate safe water
sources. An extra small pocket flashlight (something you can hold in
your mouth so your hands are free) can be handy if you have to take
care of things in the dark. Camping supply stores also market small
lightweight headlamps that work well, too.
And one last thing . . . no, your bag is not going to blow up in an
airplane. This is a myth, folks. It doesn’t happen.
Using Public Washrooms
If you need to empty your appliance in a public washroom, do it the
same way you would at home. It’s a good idea to carry a basic change
kit with you when out and about if your ostomy is a busy one; if you
need to change your appliance you can do this in a cubicle although
finding a spot to set things down will require some ingenuity. You have
a legitimate reason to use the handicapped stall if you need to change
the appliance. If you’ve left quite a smell in the stall a spray or two with
a little ostomy room deodorizer is a considerate thing to do for the
next user but really, how many ‘normal’ people do that?
Don’t rush or feel guilty about taking up extra time in a public stall. You
do what you need to do. If you’re feeling self-conscious about using
a public washroom, consider this: before you had your surgery, how
much attention did YOU pay to others in a public washroom? Chances
are the only person who might take any notice of you will be another
ostomate. People really aren’t interested in what you’re doing -- they
just want to do their business and get on with things. So should you.
Internal
(J-Pouch) Surgery
What is the ileoanal reservoir
(J-pouch) procedure?
An ileoanal reservoir, also known as pelvic pouch, ileal pouch or J-pouch
procedure is a type of surgery that involves creating an internal pouch
formed of small intestine that provides a storage place for stool in the
absence of the large intestine. This surgery eliminates the need for
an external bag to collect waste as stool now passes through the anus
rather than through an ileostomy.
It is usually a three-stage procedure, although in some cases it can be
completed in two stages.The first stage is removal of the large colon
except for a rectal stump and anal sphincters. An end ileostomy is
then created. During the second stage the internal pelvic pouch is
created from a loop of the small intestine. The third stage reverses the
ileostomy and re-connects the bowel. In very rare cases, a pelvic pouch
may be created in one step.The decision of when to complete the
later stages of the procedure depends upon when the surgeon feels it
is appropriate to re-operate. The spacing between surgeries can vary
from months to years.
Once connected, the internal pouch may take up to a year to fully
adapt. Stools will usually become thicker within 2 - 3 months,
depending on the patient’s recovery and diet. Most patients have bowel
movements an average of four to seven times a day. Functioning of the
pouch will continue to improve over time.
Possible candidates for J-pouch surgery
Common candidates for J-pouch surgery include patients who have
chronic ulcerative colitis, familial polyposis or colon cancer. Suitable
candidates must:
• have their anal canal intact
• have undamaged anal sphincters
• be strong enough to withstand three surgeries in a relatively short
period of time
Unsuitable candidates for J-pouch
surgery
Patients who would be unsuitable for this type of surgery would include
those who:
• have other medical conditions that make anesthesia and surgery
excessively risky
• are incontinent or have poor sphincter muscle tone, or who have
had previous sphincter injury
•have a diagnosis of Crohn’s disease
• have undergone partial removal of the small bowel
• are obese
• are elderly
Will bowel movements be the same as
before?
Close, but there will be differences. A person with a J-pouch internal
reservoir will always need to have more bowel movements per day
than someone with an intact set of bowels and the consistency will
be looser. As the patient adapts and the pouch stretches to normal
capacity, the number of stools per day should decrease. Most patients
have an average of four to seven bowel movements daily but this
number may be larger immediately after surgery and as the patient
begins eating.
Dietary considerations following
J-pouch surgery
Once patients are discharged from hospital, they can try new foods,
one at a time, to ensure a proper adjustment to a normal diet. Keep
in mind that each individual is different and there may be a bit of trial
and error that takes place during the months after surgery. Sometimes
a food causes a problem to one person but may not cause a problem
for another. J-pouchers must use common sense and caution with their
diet, much as someone would with a regular ileostomy.
General guidelines:
• Drinking more water is very important because the large bowel,
which re-absorbs water, is gone
• Small frequent meals should be eaten to keep some food in the
stomach all the time. Gas increases in production when the bowels
are empty.
• Eat a well balanced diet
• Eat slowly and chew your foods well
• If you insist on eating nuts, seeds or popcorn, do so in
MODERATION
Foods that may contribute to diarrhea
alcohol excessive fruit juice broccoli
cabbage
dairy spicy foods
prune juice
fatty and fried foods
Foods that help create bulk and thicken stool
applesauce
bananas hard boiled eggs
hot breakfast cereals, mashed potatoes, oatmeal,
smooth peanut butter plain pasta toast (no seeds)
white rice yogurt (with live culture).
Foods that may increase pouch output
raw fruits raw vegetables
alcohol
leafy green vegetables, spicy foods
caffeine
chocolate
Foods that may decrease pouch output by
thickening it
applesauce
bananas
boiled rice
pasta
smooth peanut butter
cheese
tapioca pudding potatoes without skins
Foods that are difficult to pass and may
contribute to a bowel obstruction
corn
mushrooms
peanuts
popcorn
nuts and seeds.
Stay hydrated! Drink at least 6 to 8 glasses of water a day. Cut down
on caffeinated beverages as these can have a diuretic effect. If you
feel you are getting dehydrated, beverages like Gatorade or Pedialyte
can restore lot electrolytes. Try to include potassium and sodium-rich
foods in your diet (ie: bananas, orange juice, tomato juice, smooth
peanut butter; or bouillon, soups, crackers, pretzels)
After recovery and adjustment, many “J-pouchers” can tolerate just
about anything they want to eat within reason.
Cautions and Potential Problems
following J-pouch surgery
“Butt-burn”
This is a burning sensation during and after defecation. This is often
due to the fact that more bile juices are moving through the body and
out the rectum. Avoid foods that may cause burning stool and anal
irritation such as coconut, peppers, spicy foods, nuts, raisins, salsa,
certain raw fruits and vegetables (oranges, apples, coleslaw, celery and
corn), popcorn, Chinese/oriental vegetables, dried fruits, and foods
with seeds.
Dehydration
Removal of the large bowel removes your natural ‘re-hydrator’. Over
time, the small intestine will take over more of the function of fluid
absorption, but it is important to be aware of the signs of dehydration.
They can include extreme thirst, dry mouth and dry skin, shortness of
breath, decreased urine output or urine that is dark in color, nausea or
abdominal cramping and achiness. If you are dehydrated, you need to
drink extra fluid and replace lost electrolytes, sodium and potassium.
Irritated skin around the anus
Warm baths are soothing for this as well as protective ointment that
can be used after each bowel movement to keep the stool off the skin.
Ask your ET nurse or doctor to recommend a protective ointment.
Incontinence or leakage of stool
This usually improves with time as your stool thickens, your pouch
stretches and your sphincters become stronger. It may help to sleep on
a small towel that can absorb leakage and avoid foods that contribute
to increased pouch output and diarrhea.
Sexual intercourse
This should be avoided in women for six weeks after J-pouch surgery
to let the reservoir heal since the vagina and rectum are very close
together. There are some women who have occasional pain with
intercourse; however this affects younger women more often than
older women. Anal sex is strongly discouraged as it may cause damage
or lead to abcesses and fistula formation.
Women who wish to become pregnant should discuss this with their
surgeon prior to J-pouch surgery. Some surgeons recommend that
women consider delaying pelvic pouch procedures due to concerns
about fertility and risk of damage to the pouch and/or anal sphincters
during pregnancy and childbirth. Although infertility is quoted as a
complication after this type of surgery there are reports indicating that
some women are able to carry their babies to term. Most J-pouch
women have caesarean sections but there are also some who have had
vaginal births after this surgery. Each patient is different and if this is
a concern for you, you should talk to your gasteroenterologist and/or
surgeon to determine your risks.
Pouchitis
Pouchitis is inflammation of the ileo anal pouch occurring particularly in
cases where the pouch was created to manage ulcerative colitis. One
of the factors that may contribute to this is that the pouch may not
be emptying adequately with each bowel movement leading to stool
lying in the pouch for prolonged periods of time. This lends itself to
overgrowth of certain bacteria. Pouchitis can happen at any time, even
months or years following surgery. Symptoms are similar but much less
acute and painful than that of ulcerative colitis. These include diarrhea
(sometimes bloody), urgency, difficulty passing stools, and pain. You
will need to see your surgeon to discuss treatment which usually
consists of a course of antibiotics. Some surgeons may recommend
taking probiotics as well.
Blockage
Signs of a blockage are similar to that of an ileostomy blockage and
may include nausea and vomiting (for more than 24 hours), abdominal
cramping, pain, bloating, and decrease in bowel activity. In the event
of a blockage, you should go to your nearest emergency room. Most
often, blockages resolve themselves within 72 hours.
Anal strictures and fistulas
Sometimes occur but these are not common complications.
Steroid dose taper
Patients who were on steroids before going into J-pouch surgery
should gradually decrease or taper their steroid dosage under their
doctor’s supervision until the steroids are no longer needed. Under no
circumstances should you abruptly stop taking your medication because
this may cause serious problems. If the steroid taper is too quick, you
may feel like you have the flu or have no energy. If during your taper
you feel as though you can’t get out of bed, call your doctor to discuss
a slower taper. In all cases of steroid taper, it is advised to check in with
your physician at regular intervals.
Improved surgical technique and treatment has made J-pouch surgery
an increasingly viable option for younger patients in recent years. The
Vancouver Chapter of the United Ostomy Association has a number of
“J-pouchers” who would be happy to share information and personal
experiences with you.
Specific
Groups
The Elderly
Senior patients can face extra challenges not the least of which is
fear of loss of independence with an ostomy. It’s especially important
that elderly patients (and their families, if possible) receive adequate
instruction and coaching on appliance management before they leave
hospital. The senior ostomate may receive home care for a period of
time to help them and their family adjust. The elderly patient’s ET and
doctor will assess how much assistance the person may need. Older
patients are as capable of managing an ostomy as those much younger,
but they may need more time to learn and remember new routines.
As we grow older, our skin loses elasticity and becomes thinner and
drier, thus becoming prone to wrinkles and irritation. These changes
can become problems for those who must wear an appliance all the
time. To prevent leakage as the skin becomes more wrinkled, one
should stand up straight when changing the appliance (using a mirror
may help you see what you are doing).
The skin over the entire body tends to bruise more easily and heal
more slowly as we age. Seniors need to be more careful when
removing an appliance. Use two hands to remove the barrier -- one
to hold the skin down so it isn’t being stretched unnecessarily, and the
other to pull the flange off.
Arthritis and lessening dexterity can make it more difficult to snap
a two-piece appliance together. You might consider a one-piece
appliance to make this easier. Using scissors to cut the flange hole
can get harder if your hands are stiff; order appliances with a pre-cut
opening if cutting is becoming a chore.
Infants and Children
The same general rules apply for ostomy management with infants
and children, although the appliances will of course be smaller. Unless
specifically recommended by your ET nurse, do not use skin preps,
paste and the like -- your baby’s skin is tender and probably doesn’t
need these products, anyway. You should check your baby’s appliance
with each diaper change to ensure it isn’t leaking or slipping. You can
bath your little one without an appliance on, although in the case of a
urostomy, you should check with your doctor about immersing your
baby in water with an uncovered stoma. Lotions, creams and powders
should be kept off the skin around the stoma. You can diaper your
infant with the pouch in or outside of the diaper, depending on the
location of the stoma. Try different ways to see what works best.
One of the biggest challenges can be trying to change the appliance
on an active infant! If you can, plan a pouch change when your baby is
quieter, perhaps in the morning or after a bath. Choose a time when
you know the stoma will be less active. If your baby is upset and crying,
wait for a bit. Cuddle him or her and give them time to calm down.
When they’re in a happier mood, the whole process will go more
smoothly for both of you!
Having your spouse nearby, or an older sibling can be an advantage
-- the extra hands may be needed plus another person can entertain or
distract an active baby during a pouch change.
Babies and small children are naturally curious and will pick or pull at
the appliance once they discover it. One piece outfits can help discourage this exploration.
OSTOMATES RECEIVING
CHEMOTHERAPY
What chemotherapy drugs your oncologist decides you should receive
will vary depending on your cancer stage and type of cancer. You
will be coached regarding how to deal with potential side effects.
Chemo drugs may have no effect on your skin or stoma, or you may
experience some changes:
ALL OSTOMIES TYPES:
Peristomal skin reactions
- Skin is more difficult to heal due to increased or decreased blood
counts. Take extra care when removing the flange -- use two hands
- Chemotherapy may cause deep red or purple skin discolouration under the pouch faceplate. Small red spots may appear under the flange due to decreased platelet counts as on other areas of skin -- let your physician know if this occurs.
Stoma Reactions
- Stomatitis - small ulcers may appear on the stoma as on the rest of the gastrointestinal tract. Your physician may recommend that stoma irrigation be stopped until stomatitis resolves itself. Don’t use solvents or irritating substances on the stoma.
- Due to decreased platelet count, the stoma may bleed when touched.
- Peristomal skin may be more prone to infection.
COLOSTOMIES AND ILEOSTOMIES
Diarrhea
- Possible reaction to chemotherapy; monitor amount of stool output; inform physician if increased significantly above normal.
- Drink adequate amounts of fluids. Nausea can sometimes make
drinking enough fluids difficult; if you’re having trouble, be sure
you’re taking your anti-nausea medication properly.
- Eat foods to help thicken stool, ie. applesauce, cheese, white rice, bananas, peanut butter, plain tea and boiled milk.
- Stay away from fatty foods, highly spiced foods and foods or beverages which cause gas or cramping.
- Potassium is lost in diarrhea and needs to be replaced. Foods high in potassium include orange juice, potatoes, bananas, soybeans,
avocados, apricots, pomegranates, parsnips and turnips. Gatorade
and similar sports drinks do not have high amounts of potassium, but
can be helpful if that’s all you can get down.
Constipation
- An occasional reaction to chemotherapy (may also be a reaction to some pain medications such as codeine)
- Drink adequate amounts of fluid, as above. Prune juice daily may be helpful.
- Eat foods with a laxative effect, ie: raw fruits and vegetables,
chocolate, coffee, cereals, bran, whole wheat bread, dried fruit and
nuts. (Remember to be cautious if eating dried fruit, nuts or raw
foods. Start with small amounts and chew THOROUGHLY.)
- Do not take strong laxatives
UROSTOMIES
Check carefully for skin infections, especially yeast, which can look like
a rash, red spots, or weeping, irritated areas. Your ET nurse should
check your skin if you suspect a yeast infection. Some chemotherapy
may turn urine colours -- don’t be alarmed. Adriamycin turns urine red,
methotrexate turns urine yellow(er). If any blood is noted in the urine,
report this to your physican immediately. Some chemotherapy drugs
need extra fluids to be adequately flushed from the kidneys -- cytosan,
cisplatinum. Drink LOTS of water.
Pregnancy with an Ostomy
Having a stoma is not a contraindication to pregnancy and delivery.
There are, however, several things the expectant mother will need to
consider during the course of her pregnancy and after delivery.
The most significant changes that will occur during pregnancy are to
the stoma (usually its height, degree of protrusion, and diameter) and
to the peristomal skin contours (dips, creases, and curves). As the fetus
grows and you begin to gain weight, the stoma may begin to protrude
less, the diameter may increase, and the skin around the stoma may
start to flatten out. The stoma may, in fact, become flush or retracted
during the latter part of gestation, though its function will not likely
alter. Changes in stomal height and diameter and in the peristomal
contours may require a change in the type of appliance you will need
to use. Switching to an alternate product is usually not required in the
first trimester and the early parts of the second trimester; however,
in the latter part of the second trimester and throughout the third trimester, alternate products may be required. It is best not to buy large
quantities of product in the latter stages of gestation because of these
changes in the stoma and adjacent skin. If you find that your appliance
is not staying on as well as before, make an appointment with your ET
nurse who can recommend adjustments.
Nausea and vomiting associated with morning sickness can be problematic if you have an ileostomy. Fluid and electrolyte imbalances can
occur rapidly under these conditions, causing dehydration, so make
sure you are drinking enough fluids throughout the day.
If you have a colostomy and irrigate, you may find that you are having difficulties getting enough water into the bowel, or inserting the
cone. It might be necessary to suspend irrigation in this case until after
delivery.
The stoma may become hard to see as you gain weight; you might
need to use a mirror to see what you’re doing. You might also consider
temporarily switching to a longer pouch to make emptying easier.
After delivery, the stoma and peristomal skin will go through changes
again: the birth of the baby may make the skin less taut, with more
wrinkles/creases than previously, and the stoma may begin to protrude
again. As you lose the weight associated with the pregnancy, you can
make adjustments to the products you are wearing.
GAY AND LESBIAN OSTOMATES
Gay and lesbian ostomates have all the same issues as the straight
population, with the added concern that some may be uncomfortable
seeking support outside of the gay community. Please -- be upfront
with your nurse or doctor about your orientation. It will help them
avoid assumptions regarding your sexual activities and social situation.
If you wish to speak with another gay ostomate, ask your ET nurse.
They’ve had gay patients before and can sometimes put you in touch
with them. In addition, your local UOA chapter can often connect you
with a gay or lesbian member or associate.
If your surgery has or is going to involve the anus/rectum, it’s imperative that sexually active gay men discuss this with their surgeon as this
activity may no longer be an option.
MUSLIM OSTOMATES
The Islamic faith has very definitive rules that must be followed in preparation and during the time of prayers. The question has arisen about
the wearing of a pouch during the time of prayer. Mr. Mohamed Hanafy
Ahmed, when he was the General Manager of ConvaTec, Middle East,
petitioned Fatwa Commission of the AL-AZHAR University for a ruling.
The Fatwa Commission is the official Islamic body governing such matters worldwide and is located in Cairo, Egypt. The following submission
is an English translation of the official response as a service to ostomates of the Islamic faith.
Question “There is a large group of patients afflicted by colon and bladder cancer
where the malignant tumor has to be removed together with the vital
organ of the body so as to prevent the spread of disease. In such cases
the natural opening of the body is by-passed and replaced by a stoma in
the abdomen to work as an outlet through which urine or stool is emitted in an involuntary manner. Pouches used for collecting such matter
are replaced when necessary.
At the time of prayers, the stoma patient is unable to change the
pouch. Is it possible for such a patient to pray while the pouch is carrying such excrements and what is the rule in such a case ?”
Answer Praised be Allah, Lord of all creatures and peace and prayers be upon
the master of messengers Mohamed, his Kin and his followers.
“In answer to this question, we reply that whoever is in such a situation is considered to have a religiously legitimate excuse. Since a stoma
patient cannot replace the pouch for each prayer, he may perform
absolution at the onset of each prayer interval. He may then pray as
many times as he may wish during this prayer interval. At the onset of a
new prayer interval, the absolution performed in the last interval is no
longer valid and the stoma patient should perform a new absolution for
the new prayer interval and so on (for each of the five prayer intervals.)
Chairman of Fatwa Commission of AL-AZHAR
Abd Allah Abd-Alkalik Al Mishad
8 Jumada 1, 1407
8 January 1987
Most
Commonly
Asked
Questions
MOST COMMONLY ASKED
QUESTIONS
Can you bathe and shower? Do you have to wear
the appliance while doing this? Can you go in a
hot tub?
YES OF COURSE you can bathe and shower. You can take the entire
appliance off too, if you want. (Remember, though that you can’t re-use
the flange; a fresh one must be applied.) Showering is good for your
skin circulation and makes you feel wonderfully clean. Plus it’s nice
to take that appliance right off on occasion. A shower head that is set
to a hard spray may feel uncomfortable on the peristomal skin (the
skin right next to the stoma) so you may need to adjust the spray to a
more gentle setting. But unless you’ve got a real blaster of a shower
you won’t hurt your stoma if the spray hits it. If it feels comfortable,
spray away. If not, cover your stoma with your hand or stand in such
a manner that it’s out of the line of fire. What if your ostomy starts
working while you’re in the shower? Don’t worry about it. Rinse
yourself and the tub/stall extra well and throw a little cleaner down
the drain. You can take long baths too but ileostomies and urostomies
should keep the appliance on for this. Tape the filter closed. Your flange
will begin to melt off the longer you’re in there and may need to be
replaced when you get out. All ostomates can go in a hot tub as well,
but you may want to tape the edges of the flange so it’ll hold. You may
need to change the flange when you get out if it’s melted down too
much.
Can You Swim? Snorkel? Dive?
Definitely. If you have a filter on your appliance this should be taped so
water doesn’t damage the filter. Filters work poorly or not at all once
they’re wet or even damp. Some people tape the flange edges, some
don’t. If you’ve changed your flange before swimming it’s a good idea
to wait an hour before going in to make sure it has adhered properly.
If you wear any sort of wet suit for water sports you should of course
empty the appliance before suiting up and you may need to come
back up to re-empty sooner than your diving companions. You don’t
necessarily have to buy special swim suits to go swimming. One piece
or two-piece swimsuits that are high enough to cover the appliance
work well for women. Consider buying something with a pattern or
a skirt to make the outline of the appliance less visible. Board shorts
are a popular choice for men who may opt to also wear biking shorts
underneath for extra security. Remember that the great majority of
‘normal’ people have lumps, bumps and imperfections on their bodies
-- very few of us are model-perfect in the first place -- and nobody is
going to be staring at you. There are ostomy swimwear companies that
make custom clothing if regular suits aren’t working for you.
What if it makes a noise in public?
There is no way to stop your ostomy from expelling gas. Ileostomies
and colostomies will emit gas, which may or may not be audible to
others. Snug clothing can help muffle a noisy stoma, as can a hand
or forearm pressed over it. Stoma noises often sound the same as a
rumbling stomach and since the sound is coming from the front of
your body people often assume it’s just your stomach if they notice
any sound at all. Ambient noise or clothing makes most stoma noises
inaudible, but if this is embarrassing you, consider cutting down on
or eliminating gas-producing food or drink. Bear in mind that you’re
going to be hyper-sensitive to your own stoma sounds for a while.
What sounds loud to you may not even be noticed by others. A polite
‘Excuse me’ works as well!
Sometimes the Stoma Bleeds -- What do i do?
Stomas will bleed if cleaned too roughly, if the appliance is improperly
applied, or if you accidentally scratch them with fingernails or cloth.
This is normal and looks like spotting; it should stop soon if you dab
the spots with tissue. Some stomas will bleed more easily than others,
and certain medications (such as aspirin) can increase the likelihood of
bleeding. Prolonged bleeding, increased amount of bleeding or very
easy bleeding may indicate other problems and should be reported.
Nothing has come out all day -- is something
wrong?
Just as people with an intact set of bowels can get constipated, so
can you if you have a colostomy. So long as you feel well otherwise,
periodic inactivity doesn’t mean anything is wrong. Drink grape or
prune juice if things haven’t moved in a 24 hour period. Give your
body a chance to sort itself out before resorting to laxatives, and if you
do, take such products sparingly. Prolonged lack of output from an
ileostomy or urostomy is NOT normal and should be reported to your
doctor or ET.
Can I wear the same clothes as before?
In most cases, yes! Make sure, if possible, to have your stoma site
properly located by an ET nurse before surgery. It should be placed in
a spot that won’t be irritated by the type of clothing you like to wear.
While you are healing you may want to wear garments with a loose
waistband, such as track pants. Swelling in your abdomen after surgery
will subside and in most cases, patients can return to the wardrobe
they liked before surgery and this can include form-fitting outfits. If
you liked wearing extremely tight or low-cut jeans or pants before,
unfortunately it might be best to give those away. Pants that are really
tight over the stoma won’t allow waste to drop properly into the bag.
Depending on body type, some stomas may have to be located higher
than usual. If this is the case with you, you can opt to wear pants or
skirts higher in the waist. Or, you can take the opposite approach
and wear your clothing lower on the hips with a shirt worn out over
top. Men sometimes find suspenders to be a good addition to their
wardrobe.
When Can I Return to Work?
Your doctor will be the best judge of when you are fit enough to
resume work. If your job involved heavy physical activity, you need to
let your doctor know this so he or she can recommend any changes
in duties that may be necessary. In most cases patients can resume
their former employment without problems. It can take months to
regain former strength and stamina however, so you should discuss the
possibility of shorter hours or part-time shifts with your employer for
the first few weeks. It’s also best to explain that you may need to take
more bathroom breaks than before. (It could also be possible that you
won’t need to use the bathroom as often as you did before!)
Tips &
Tricks
TIPS AND TRICKS
•
The best tip for changing an ileostomy is to be prepared and organized before you start, and do your change as efficiently as possible. The more you wipe and fool around with the stoma, the more opportunity it will have to produce output when you least want it to.
• To help stop ileostomy discharge during a change, delay eating a meal and eat some plain marshmallows up to 30 minutes before changing the appliance.
•
Make sure your paristomal skin (the skin around the stoma) is completely dry before applying the flange. Bathrooms can be warm and humid after a bath or shower -- give your skin plenty of time to dry thoroughly.
• A few drops of pouch lubricant inside the top of the appliance will help prevent ‘pancaking’ of stool around the stoma. Most of the manufacturers make such lubricants, ask for a sample.
• Use two hands to remove a flange -- one to hold the skin down and the other to gently peel the flange off. Try to minimize how much you are stretching or pulling on the skin.
• Write the day you change your appliance in ink on the outside of the barrier itself to help you remember when it’s time to change again, or keep a calendar in the bathroom for this purpose..
• If using a hairdrier to speed up drying of the peristomal skin during a change keep it on LOW setting. High heat can burn delicate stoma tissues.
• If your paste tube has become too hard to squeeze, put it in a glass of hot water for 20 minutes.
• If you are being admitted to hospital for tests or any other reason, take your own ostomy supplies with you! The hospital may not
stock what meets your particular needs, or attending nurses may not be familiar with ostomies. Even if the hospital has what you require, it may take a bit of time to locate it.
• If shaving abdominal hair, use an empty cardboard toilet roll as a shield around the stoma. Shave in the direction of hair growth.
• Oatmeal added to your bath can relieve itchy skin. Pour some oatmeal into a cloth bag or a piece of cheesecloth, tie it shut and put it into the bathwater. You can also use the oatmeal bag like a sponge to soothe irritated skin.
• If you use alcohol to clean adhesive residue off peristomal skin, use it sparingly. Try to avoid over-use of alchohol to clean your skin.
• Don’t use the same flange too long. The shape and size of your
stoma, body contours, and type of waste all have a bearing on the
durability of the seal. It is not adviseable to leave an appliance in
place for more than 7 days as ‘hidden’ seepage or leakage can occur
under the flange. You can extend wear time only if your skin is in
very good condition, and there is no evidence of seepage on your
skin.
• If you use skin sealant, make sure it dries completely before
applying the flange.
• Pay attention to skin problems. Address signs of skin irritation
immediately. If you’re not sure what to do, call your ET.
• Don’t wrap the drainable pouch tail around and around the clamp before closing it. This will not make the clamp work better, it will just spring it out of shape. Replace your old clamp with a new one if it shows signs of loosening.
• Don’t let the pouch get full before emptying. Excess weight will separate a two-piece system and will also put too much weight on the skin barrier resulting possibly in multiple problems. Empty the pouch when it is about one-third full, or sooner.
• You don’t need to wear gloves to change your appliance. When
you were discharged from hospital, your kit may have contained
latex gloves. Since your nurses and doctors usually wore gloves
when tending to you, you might be led to believe you should always
wear gloves when changing your appliance. There is no need to
wear such things while maintaining personal hygiene. (Have you
had children? Did you wear gloves when changing your little ones’
diapers? Of course not. You’re no more unclean than they were.)
• If urine is collected for urinalysis be sure your doctor and nurse
know a sterile specimen must be taken directly from your stoma
and not from the pouch. Bacteria builds up in the pouch quickly and
may give false test results. If they are not sure how to do this, do
the following:
• remove your pouch
• clean the stoma
• catch the urine in a sterile cup
• An ostomy belt can help keep your appliance secure if you’re having trouble keeping it in place.
• Try tips from other ostomates that might apply to issues you have but remember everyone is different. What works for one person may not work for another but it’s worth a try.
•
Perhaps the most important bit of advice is don’t get down on yourself if you make mistakes! We’ve all made mistakes and sometimes we still do. Learn from any errors you may make and keep moving forward.
Emotional
Issues for the
Patient and
their Family
Coming Home
You will be discharged from hospital after your doctor and/or ET nurse
is confident that you have recovered sufficiently from your surgery and
understand the basics of stoma management. No doubt you will be
glad to be in familiar surroundings again but coming home with a new
ostomy can be a difficult time. The reality of what has happened may
hit once you are out of the hospital, away from the everyday routine
of the ward, once the visitors and flowers are gone. It may be a shock
to discover that you feel worse, emotionally, when you get home. You
wouldn’t be the only one who has felt that way.
Give yourself time. You’ll feel weak and uncomfortable during the early
weeks or months and may wonder if you’ll ever feel like your old self
again. The task of caring for a new ostomy can seem overwhelming
and you may feel dismayed at all the new things you need to do and
remember. You may experience sadness, frustration, anger or depression -- all these feelings are normal and we all went through them in
the beginning. Just as it takes time for the body to heal, it also takes
time to heal emotionally from this kind of surgery. It’s common to have
negative feelings and far better to release them through tears or talking than to bottle them up. Negative feelings or withdrawal cannot be
allowed to become a way of life, however. Fundamental management
techniques must be learned, and new experiences or problems that
may develop can be met and managed as they occur. As you learn and
master the skills needed, you will gain in confidence.
You don’t have to like your ostomy. You DO have to learn how
to live with it.
Ostomy patients can fear being shunned or pitied by others. We have
all felt the dread of losing our independence, our self-confidence and
our dignity. Such reactions are universal and valid. It’s important, however, for the new ostomate to realize that how they see themselves
will be how others see them. If you are embarrassed and ashamed,
those around you will reflect that. If you think you can’t do something
and refuse to try, others will gradually assume you are incapable. You
have a responsibility to live your life fully and to provide an example of
triumph over adversity, courage over despair and pride over pity.
There is no answer for “Why Me?” No illness or injury is fair. Rather
than question why this has happened to you, give some thought to
how you will live your life from this point on, for you have indeed been
given a second chance. Not all patients get to come home from
hospital. You did.
Spouses, family and caregivers
This is a change in your life, too. Your loved one may cope well with
the ostomy and resume former activities at a surprising rate. Some
individuals need more time to regain their confidence. There is no set
timetable, we all adjust at our own speed. It is important however, for
a new patient to resume their normal routine as before, and to learn
to manage their ostomy by themselves. Unless your family member
is physically unable to change their own appliance, they should not be
relying on you to do this for them. Independence is vital to regaining
self-esteem. Dealing with a new ostomy can be frustrating so encouragement and patience may be needed. Family members and loved ones
should be aware that coming to terms with an ostomy is a process that
can involve grieving for what has been lost.
Just as a new ostomy patient can feel overwhelmed with it all, you may
feel overwhelmed yourself. If this is the case, seek out other spouses
or caregivers with whom you can share your feelings. SASO (Spouses
and Significant Others) is a volunteer group formed by spouses and
partners of ostomates for the purpose of providing support and
encouragement to the spouses of new patients. Contact your local
UOA chapter for SASO contacts in your area.
Additional
Resources &
Information
OSTOMY MANUFACTURERS
The most prevalent brands of ostomy products in Canada are
Convatec, Coloplast and Hollister. Less well-known but definitely
worth a look companies are CyMed, Nu-Hope, Marlen and SALTS.
We strongly encourage all those with an ostomy to try new products
and experiment to find the best possible match for your needs.
Ostomy companies want you to try their products! Don’t be shy
about contacting them. All will supply free samples upon request. This
is an ideal way to ‘test-drive’ different products without cost. The
following companies have toll-free numbers you can call to request
samples. When calling, you should specify the type of ostomy you have,
what your stoma size is, and any particular concerns you may have.
Not sure what size your stoma is? You should have been given a
measuring template by your ostomy nurse, or you will find one in your
current ostomy supplies. If you have misplaced or lost these, your
nurse or any supplier will gladly give you one free of charge.
It can take time and some trial and error to find the right products
for you. Free samples can take up to several weeks to arrive, so be
patient.
ARGYLE MEDICAL DISTRIBUTORS Inc.
(distributors of SALTS Healthcare ostomy products)
1-877-927-4953
COLOPLAST
Toll-free phone:
1-888-880-8605
1-866-293-6349
Toll-free fax:
1-877-820-8206
Monday to Friday, 8:00 am to 6:00 pm (Eastern Standard Time)
CONVATEC
Toll-free phone: 1-800-465-6302
Toll-free fax:
1-877-437-1777
Monday to Friday, 8:00 am to 7:00 pm (Eastern Standard Time)
CYMED (pronounced “sigh-med”)
Toll-free phone:1- 800-582-0707
Monday to Friday (8:00 am to 5:00 pm) (Pacific Standard Time)
HOLLISTER
Toll-free phone:
1-800-263-7400
Monday to Friday, 7:00 am to 5:45 pm (Central Standard Time)
MARLEN
Sometimes available upon request from suppliers.
NU-HOPE
Toll-free phone: 1-800-899-5017
Monday to Friday, 8:00 am to 4:30 (Pacific Standard Time)
OSTOMY SUPPLIERS
It is not possible for us to list all ostomy suppliers in the Vancouver area
-- these are some of the ones with a product selection on site if you
want to take a look in person. If you reside in an outlying area, you
can consult your ostomy nurse for dealers who live closer to you. You
can also inquire about free delivery service offered in your area. Many
suppliers offer full-time or part-time ET nurse clinics. Call to inquire
regarding ET consultation services. Some suppliers will also supply
samples of products upon request -- call to inquire.
DAVIES PRESCRIPTIONS AND PHARMACY
1401 St. Georges (across from Lion’s Gate Hospital)
North Vancouver, BC V7L 3J3
604-985-8771
ET RESOURCES LTD.
#1 - 1381 George Street
White Rock, BC
V4B 4A1
604-536-4061 or toll-free: 1-877-386-8773 (1-877-ET-NURSE)
Fax: 604-536-4018
LANCASTER MEDICAL
601 West Broadway
Vancouver, BC V5Z 4C2
604-873-8585 (Vancouver)
604-526-3331 (Burnaby)
604-582-9181 (Surrey)
MACDONALD’S PRESCRIPTION #3 KITSILANO
2188 West Broadway
Vancouver BC
604-738-0733
NIGHTINGALE MEDICAL SUPPLIES LTD. (formerly KEIR)
125-408 East Kent Ave. South
Vancouver, BC V5X 2X7
604-879-9101 or toll-free 1-800-663-5111
FAX: 604-879-3342
OSTOMY CARE & SUPPLY CENTRE
2004-8th Avenue
New Westminster, BC V3M 2T5
604-522-4265 or toll-free 1-888290-6313
REGENCY PRESCRIPTIONS & MEDICAL SUPPLIES
1144 Burrard Street (across from ST. Paul’s Hospital)
Vancouver, BC V6Z 2A5
604-688-4688
(note: there are several Regency outlets throughout the lower
mainland; consult your phone book to find those that stock ostomy
supplies in your area)
SHOPPERS HOME HEALTH
2790 Oak Street (near Vancouver General Hospital)
Vancouver, BC V6H 0A5
604-876-4186
(note: there are several Shoppers Home Health outlets throughout the
lower mainland and BC; consult your phone book to find those that
stock ostomy supplies in your area)
Does Medical Coverage Include ostomy
Supplies??
BC’s Fair Pharmacare plan which was implemented in May of 2003
subsidizes eligible ostomy products. The deductible you will pay for
your supplies will vary depending on your annual income, based on the
tax year two years prior (ie: your 2012 coverage would be based on
your 2010 reported income) If you have experienced a drop in annual
income, you should contact Pharmacare to ensure your deductible
reflects this change in finances. Extended medical plans such as
Blue Cross will provide considerable coverage after a minor yearly
deductible. To receive up to date Pharmacare coverage you must
submit an annual income tax statement.
What’s covered?
Basically anything for use specifically with ostomy management is
eligible, such as:
- all types of pouches, flanges, stoma caps, stoma patches
- irrigation and night drainage kits
- paste, skin prep, ostomy adhesive remover
- Micropore tape
- Devrom
- ostomy belts
Examples of products NOT covered are:
- any brand of tape other than Micropore
- liquid ostomy deodorant (figure that one out!)
- hernia belts
- general skin care or first aid supplies
- Imodium, Metamucil and similar products
If you are unsure about coverage for any products you use, contact
Pharmacare directly or inquire at your ostomy supplier. For questions
about how to receive your maximum financial assistance under
PharmaCare or how to register, call toll-free in BC:
1-800-387-4977
8:00 AM to 8:00 PM weekdays
8:00 AM to 4:00 PM weekends
ET clinics and Out-Patient resources
The following is a list of pre-surgical counselling and post-surgical
follow-up clinics. Some services are offered in hospital, others are available as out-patient clinics at local ostomy suppliers. Call for availability
and appointment times. Most out-patient clinics offer appointments
with an ET nurse free of charge, some may charge a fee for this service. Hours vary at retail clinics, call to inquire. Note: suppliers in your
area may offer ET clinics not listed here -- call to inquire.
HOSPITALS
Vancouver General Hospital . . . . . . . . . 604-875-5788
(Vancouver)
St. Paul’s Hospital. . . . . . . . . . . . . . . . . . 604-682-2344
(Vancouver)
ext. 62917
Children’s Hospital. . . . . . . . . . . . . . . . . . 604-875-2345
(Vancouver)
local 7658
Lion’s Gate Hospital . . . . . . . . . . . . . . . . 604-984-5871
(North Vancouver)
Royal Columbian Hospital . . . . . . . . . . . . 604-520-4292
(New Westminster)
Ostomy Care and Supply Centre. . . . . . . 604-522-4265
(New Westminster)
Surrey Memorial Hospital . . . . . . . . . . . . 604-588-3328
(Surrey)
Langley Memorial Hospital. . . . . . . . . . . 604-514-6000
(Langley)
ext. 5216
M.S.A. General Hospital. . . . . . . . . . . . . . 604-853-2201
(Abbotsford)
ext. 7453
Chilliwack General Hospital . . . . . . . . . . 604-795-4141
(Chilliwack)
ext. 447
Peach Arch Hospital . . . . . . . . . . . . . . . . 604-531-5512
(White Rock)
local 7687
E.T. Resources Ltd.. . . . . . . . . . . . . . . . . . 604-536-4061
(White Rock)
Richmond General Hospital . . . . . . . . . . 604-278-9711
(Richmond)
ext. 5235
CLINICS
ET Resources Ltd. . . . . . . . . . . . . . . . . . . 604-536-4061
(White Rock)
Macdonald’s Prescriptions . . . . . . . . . . . 604-738-0733
(Kitsilano)
Nightingale Medical Supplies Ltd.. . . . . . 604-879-9101
(Vancouver)
Ostomy Care & Supply Centre . . . . . . . . 604-522-4265
(New Westminster)
connect with others on the internet
The internet has radically changed how we gather information and
network with other ostomates. From product information, advances
in treatment and surgical technique, to fellowship and support, there
is a wealth of information online. Just as we encourage new ostomates
to try different products and to join and participate in local ostomy
support groups or chapters, we encourage those with access to a
computer to look into some of the following sites. They will inform,
entertain, reassure, and above all, let you know you are not alone.
OSTOMY DISCUSSION BOARDS
These boards deal with every conceivable ostomy type, issue and
concern. All are free, as anonymous as you wish, and moderated for
taste and privacy. These are not chat rooms, although some have chat
areas.
UOAC (Canada) Discussion Board
https://ostomycanada.ca/forums/index.php
Shaz’s Ostomy Pages
http://ostomates.org/forum/forumdisplay.php?f=4
Ostomyland
http://www.ostomyland.com/ostomyland/
UOAA (United States) Discussion Board
https://www.ostomy.org/forum/index.php
UOAC WEBSITES
http://www.ostomycanada.ca/
UOAC List of Chapters
http://www.ostomycanada.ca/chapters
Vancouver Ostomy Association
http://www.vcn.bc.ca/ostomyvr/
Okanagan Mainline Ostomy Association
http://members.shaw.ca/okostomy/okostomy_5.html
Peace District Ostomy Association
http://www.peaceostomy.com/
Calgary Ostomy Society
http://www.calgaryostomysociety.ca/
Edmonton Ostomy Association
http://www.ostomyedmonton.com/
Saskatoon Ostomy Association
http://www.saskatoonostomy.ca/
Regina Ostomy Association
http://www.reginaostomychapter.com/
Winnipeg Ostomy Association
http://www.ostomy-winnipeg.ca/
Ostomy Toronto
http://www.ostomytoronto.com/
Ostomy Ottawa
http://www.ostomyottawa.ca/
Hamilton Ontario Ostomy Association
http://www.inform.hamilton.ca/record/HAM0235
London & District Ostomy Association
http://www.ostomyassociationlondon.com/
Niagara Ostomy Association
http://www.niagaraostomy.com/
Ileostomy/Colostomy Association of Montreal
http://www.aicm-montreal.org/
International Ostomy Association
http://www.ostomyinternational.org/
MISC
United Ostomy Associations of America
(http://www.uoaa.org/
Colorectal Cancer Society of Canada
http://www.colorectal-cancer.ca/
Badgut Gastrointestinal Society
http://www.badgut.org/
Canadian Cancer Society
http://www.cancer.ca/
Crohn’s and Colitis Foundation of Canada
http://www.ccfc.ca/
Friends of Ostomates Worldwide (FOW)
http://www.fowc.ca/
HealthLink BC - Healthy Eating with IBD
http://www.healthlinkbc.ca/healthyeating/managingyourcondition/
digestivegastrointestinalconditions.html
Evansville Indiana Ostomy Chapter
http://evansville-ostomy.org/
The J-Pouch Group
http://jpouch.org/
Canadian Association of Enterostomal Nurses
http://www.caet.ca/caet-english/education-colostomy-guide.htm
About the UOA Vancouver
The Vancouver Chapter of the United Ostomy Association began over
40 years ago as the dream of Miss May Fawcett, a forthright, outspoken,
Fort Macleod, Alberta, school teacher who moved to Vancouver in the
1950’s and worked as a salesperson for a major Vancouver printer, until
her passing in St. Paul’s Hospital in 1987.
May had her ileostomy surgery in 1967 at St. Paul’s and soon
discovered there was no organized help or support for ostomates in
British Columbia. Once they left the hospital, new ostomates pretty
much had to experiment and figure things out on their own with the
help of eager, but inexperienced salespersons in the ostomy appliance
retail shops. Miss Fawcett, mercifully, set out to change all that.
In 1968, with the help of her surgeon, Dr. E. N. McHammond
and his brilliant and dedicated associate, the now retired, Dr. Kenneth
Atkinson, May set about organizing a local support group for new and
existing ostomates in the Vancouver area and in the summer of 1968 the
Ileostomy Association of British Columbia (IABC) was registered as a
non-profit Society with the Provincial Government in Victoria, with May
as President and Bea Brail as Treasurer. There were 30 members, annual
membership fees were $3.00 and monthly meetings were held at G. F.
Strong Rehabilitation Centre at 900 West 27th.
From the beginning the IABC affiliated with the United Ostomy
Association in the USA, headquartered in Los Angeles. Miss Fawcett
also volunteered as a Provincial Representative and was instrumental in
organizing Ostomy Chapters throughout British Columbia and Alberta.
In November of 1970 the IABC became the United Ostomy Association
of British Columbia and later the Vancouver Chapter of the UOA.
On June 12, 2000, the Vancouver Chapter, along with almost all
other Canadian Chapters, bid a fond thank you to the wonderfully
helpful UOA in the USA and joined the new Canadian group, the United
Ostomy Association of Canada. The UOAC was formed in 1991, after
lengthy and tireless efforts of the late Alan Porter of the Hamilton,
Ontario chapter.
The Vancouver Chapter serves all municipalities in the lower
mainland and publishes a newsletter ‘HighLife’ six times yearly, and holds
4 meetings per year in Vancouver. Attendance at meetings is free, and
all are welcome regardless of whether or not you have an ostomy. For
more information on meeting times and dates, please see our website:
www.vcn.bc.ca/ostomyvr
Interested in joining our chapter? Please fill out the application below.
We’d love to meet you.
MEMBERSHIP APPLICATION
Vancouver Chapter United Ostomy Association
Membership in the UOA of Canada is open to all persons interested in
ostomy rehabilitation and welfare. The following information is kept
strictly confidential.
Please enroll me as
q new
Vancouver Chapter of the UOA.
q renewal member of the
I am enclosing my annual membership dues of $30.00. I wish to make
an additional contribution of $_______ , to support the programs and
activites of the United Ostomy Association of Canada. Vancouver Chapter
members receive the Vancouver Ostomy HighLife Newsletter six times
yearly, become members of the UOA Canada, and receive Ostomy Canada
magazine twice yearly.
Name: ___________________________________________________
Address: __________________________________________________
_________________________________________________________
City: ____________________________ Postal Code ______________
Phone: __________________________ Year of Birth ______________
email: ___________________________________________________
Type of ostomy:
q colostomy
q ileostomy
q urostomy
q continent ostomy
q internal pouch
other (specify) _____________________________________________
email newsletter?
q yes
q no
Contributions of $20 or more will be issued a tax receipt.
Please make cheque payable to:
UOA Vancouver Chapter
and mail to:
Vancouver United Ostomy Association
PO Box 74570, 2768 West Broadway, Vancouver, BC V6K 2G4
UOAC Vancouver, Canada wishes to thank the following publications,
associations, websites and manufacturers for reference material:
Evansville Re-route
Ostomy International Magazine
Metro Halifax Ostomy News
Regina Ostomy Newsletter
The British Hernia Centre
Ottawa Ostomy News
Coquitlam UOAC
Ostomy Toronto
Prince George Ostomy Hotline
Argyle
Coloplast
Convatec
Cymed
Hollister
Marlen
Nu Hope
Ostomy International
Winnipeg Ostomy Association
New Directions, Ft. Worth, TX
Stratford & District, ON
Mayo Clinic On-line
Wound, Ostomy and Continence Nurses’ Society
A Handbook for New Ostomy Patients was conceived and produced by Vancouver
UOAC member Debra Rooney in 2006. Many thanks to chapter members Arlene
McInnes, Sandra Dunbar, Betty Taylor, Martin Donner and Shabita Teja and to
ET nurses Andy Manson, Muriel Larson, Anne Marie Gordon, Neal Dunwoody and
Elaine Antifaev for proofreading, input and advice.
NOTES
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A Handbook for New Ostomy Patients

Transcription

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